Cervicofacial irradiation : Repercussion on the oral environment. - ROS - 2005 - Tome 34 - N°3

Most of the patients treated for ENT cancer such as carcinoma are of identical profile : male or female, around 50 years of age, having a significant history of alcohol and tobacco use for several years, and presents poor oral hygiene. The treatments require surgery, radiotherapy and chemotherapy. These therapies are involved in the curative plan proved to be very effective and compensate for the invalidating origin of the side effects, which concerns mastication, phonetics, deglutition and the aesthetic aspect. Radiotherapy is the treatment of choice for a tumor or for a complimentary post-surgical treatment. Currently, the most often used radiotherapy in ENT is the external radiotherapy; the curietherapy or radium therapy is not indicated except in very precise cases. A patient who has undergone cervicofacial radiation therapy may present physiologic particularities that are manifested in the oral environment such as xerostomia, osteofibrosis, coating and the fragility of the oral tissues to mechanical and chemical aggressions. These modifications implicate eventual complications among which are osteoradionecrosis and post-radiation dental caries. Osteoradionecrosis is a latent risk, which can be manifested at the any moment as soon as the bone has been irradiated. The risk is increased in the case of dental extraction or mucous membrane ulceration; where it is necessary to establish the proper and practical rules in an irradiated site. To anticipate the degradation of the oral tissues, a pre-radiotherapeutic oral treatment must be prepared by fluoridization. The dental treatment is done primarily at the specialized level, for the surveillance and surgery of the irradiated site. On the other hand, conservative treatments and prosthetics can be done in the dental clinic.